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USMLE Reproductive > Pathology - Ovary and uterus > Flashcards

Pathology - Ovary and uterus Flashcards

1
Q

What are the 2 layers of the endometrium?

A
  • Functionalis layer (shedded) (outer layer)

- Basalis (regenerative) layer - regenerates functionalis

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2
Q

What is asherman syndrome?

A

Secondary amenorrhea due to loss of basalis (regenerative) layer and scarring

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3
Q

What can ashermans be due to?

A
  • Overaggressive dilation and curettage (removal of tissue often for diagnosis or as treatment) or abortion
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4
Q

What is a anovulatory cycle?

A

Cycle with lack of ovulation

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5
Q

What can primary ovarian insufficiency also be called?

A

Premature ovarian failure

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6
Q

What is primary ovarian insufficiency?

A
  • Premature atresia of ovarian follicles in females of reproductive age (before 40)
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7
Q

What are the common causes of primary ovarian insufficiency?

A
  • Idiopathic (most common)
  • Chromosomal anomalies (esp < 30 yrs)
  • Autoimmunity
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8
Q

What are the most common causes of anovulation?

A
  • Pregnancy
  • PCOS
  • Obesity
  • HPO axis abnormalities/immaturity
  • Premature ovarian failure
  • Hyperprolactinemia
  • Thyroid disorders
  • Eating disorders (low BMI)
  • Cushing syndrome
  • Adrenal insufficiency
  • Chromosomal anomalies (Turner’s)
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9
Q

What is functional hypothalamic amenorrhea due to?

A
  • Calories burned greater than consumed - low BMI or increased stress
  • Functional disruption of pulsatile GnRH secretion - decreasing LH, FSH and estrogen
  • Pathogenesis includes decreased leptin (due to less fat) and increases cortisol (stress, exercise)
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10
Q

What are the components of the female athlete triad?

A
  • Decreased calorie availability/ excessive exercise
  • Decreased bone mineral density
  • Menstrual dysfunction
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11
Q

Describe the pathogenesis of PCOS

A
  • Hyperinsulinemia and/or insulin resistance
  • This alters the hypothalamic hormonal feedback response, increasing LH to FSH ratio increasing androgens from theca interna cells
  • This decreases rate of follicular maturation resulting in unruptured follicles (cysts) + anovulation
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12
Q

What does PCOS present with?

A
  • Decreased fertility
  • Amenorrhea/oligomenorrhea
  • Hirsutism
  • Acne
  • Unopposed estrogen from repeated anovulatory cycles
  • Obesity
  • Acanthosis nigricans
  • Enlarged bilateral cystic ovaries
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13
Q

What disease does PCOS increase the risk of?

A

Endometrial cancer due to unopposed estrogen

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14
Q

How is PCOS treated?

A
  • Cycle regulation via weight reduction (decreased peripheral estrone formation)
  • OCPs (prevents endometrial hyperplasia due to unopposed estrogen)
  • Clomiphene (ovulation induction)
  • Antiandrogen (spironolactone, finasteride, flutamide)
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15
Q

What drug can induce ovulation?

A

Clomiphene

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16
Q

What is primary dysmenorrhea due to?

A

Uterine contractions to decrease blood loss -> ischemic pain
- Mediated by prostaglandins

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17
Q

What is primary dysmenorrhea treated with?

A

NSAIDs

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18
Q

What is a follicular cyst due to?

A

Unruptured Graafian follicle

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19
Q

What are follicular cysts associated with?

A
  • Hyperestrogenism

- Endometrial hyperplasia

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20
Q

What is the most common ovarian mass in young females?

A

Follicular cyst

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21
Q

What is a theca lutein cyst also known as?

A

Hyperreactio luteinalis

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22
Q

What are theca lutein cysts due to?

A

hCG overstimulation

- Associated with choriocarcinoma and hydatidiform moles

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23
Q

What is the action of estrogen on the endometrium?

A

Growth p(proliferative phase)

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24
Q

What does hemorrhage into the corpus luteum result in?

A

Hemorrhagic luteal cyst

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25
Q

What are the 3 areas tumors can arise from in the ovary?

A
  • Epithelium
  • Germ cells
  • Sex cord stroma
    Tumors may also be from metastases
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26
Q

What are the 2 most common surface epithelial tumors?

A
  • Serous cystadenoma

- Mucinous cystadenoma

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27
Q

How can you differentiate benign and malignant epithelial cysts on gross and histological examination? (cystadenoma v cystadenocarcinoma)

A
  • Benign - simple, flat lining (gross) + single layer histologically
  • Malignant - Thick shaggy lining (gross)
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28
Q

Who typically gets cystadenomas (benign epithelial)?

A

Premenopausal

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29
Q

Who typically gets cystadenocarcinomas?

A

Women 60 -70 yrs old

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30
Q

Do borderline tumors (between malignant and benign) carry metastatic potential?

A

Yes

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31
Q

What may mucinous cystadenomas cause?

A

Pseudomyxoma peritonei

- Intraperitoneal accumulation of mucinous material

32
Q

What does Brenner tumour look like?

A

Solid pale yellow-tan tumour that appears encapsulated

33
Q

What does Brenner tumor look like on histology?

A

“Coffee bean” nuclei on H&E stain

- Contains uroepithelium

34
Q

What is the most common malignant ovarian neoplasm?

A

Serous carcinoma

35
Q

What does serous adenocarcinoma contain on histology?

A

Psammoma Bodies

36
Q

Where can a mucinous carcinoma be from?

A

Metastasis from appendiceal or GI tumours

37
Q

What may ovarian tumours present with?

A

> 55 years old

  • Abdo distension
  • Bowel obstruction
  • Pleural effusion
38
Q

How is the response of an ovarian tumor to therapy usually measured/

A

CA 125 levels

- Once removed should be zero

39
Q

What can increase the risk of ovarian tumours?

A
  • Advanced age
  • Infertility
  • Endometriosis
  • PCOS
  • Genetic predisposition (BRCA, Lynch, strong FH)
40
Q

What can decrease the risk of ovarian tumours?

A
  • Pregnancy
  • Breastfeeding
  • OCPs
  • Tubal ligation
41
Q

What are malignant epithelial endometrioid carcinomas related to?

A

Endometriosis

42
Q

What are the different types of epithelial tumors of the ovary?

A
  • Serous cystadenoma
  • Serous carcinoma
  • Mucinous cystadenoma
  • Mucinous carcinoma
  • Brenner tumour
  • Endometrioid tumour
43
Q

What are some of the symptoms of epithelial ovarian tumours?

A
  • Present late (poor prognosis)
  • Vague abdo symptoms (pain, fullness)
  • Signs of compression (urinary frequency)
44
Q

Where may epithelial tumors of the ovary spreafd?

A

Locally - peritoneum

45
Q

What percentage of ovarian tumours are germ cell tumors?

A

15% - 2nd most common

46
Q

Who are affected by germ cell tumours?

A

Young women - repro age

47
Q

What are the different types of germ cell tumors?

A
  • Mature cystic teratoma
  • Immature teratoma
  • Dysgerminoma (most common)
  • Yolk sac tumor
  • Embryonal carcinoma
48
Q

What is the most common ovarian tumour in young females?

A

Mature cystic teratoma

49
Q

What percentage of cystic teratomas are bilateral?

A

~ 10%

50
Q

What may be contained in mature cystic teratomas?

A

All 3 germ layers

- Teeth, hair, thyroid, gut, sebum

51
Q

What can mature cystic teratomas turn into (rare)?

A

Squamous cell carcinoma

52
Q

A monodermal form of mature cystic teratoma with thyroid tissue and thus hyperthyroidism is called what?

A

Struma ovarii

53
Q

What can mature cystic teratomas cause which may elicit pain?

A
  • Ovarian enlargement and possibly torsion
54
Q

What type of teratoma has malignant potential?

A

Immature

55
Q

What type of tissue is contained in an immature teratoma?

A

Fetal tissue

- Neuroectoderm -> immature/embryonic like neural tissue

56
Q

What is the most common malignant germ cell tumor?

A

Dysgerminoma

57
Q

What do dysgerminoma contain on histology?

A

Large cells with clear cytoplasm and central nuclei

- Sheets of uniform ‘fried egg’ cells

58
Q

What is the testicular counterpart of a dysgerminoma?

A

Seminoma

59
Q

What may be elevated in a dysgerminoma?

A

hCG and LDH

60
Q

What is the most common germ cell tumor in children?

A

Endodermal sinus tumor (yolk sac tumor)

61
Q

What does a yolk sac (endodermal sinus) tumor look like?

A
  • Yellow, friable (hemorrhagic) mass

- Schiller- Duval bodies (like glomeruli on histology) in 50% of cases

62
Q

What is the tumor marker for yolk sac (endodermal sinus) tumor?

A

alpha fetoprotein

63
Q

What type of germ cell has large primitive cells and is aggressive? (may metastasise)

A

Embryonal carcinoma

64
Q

What are the different types of sex cord stromal tumors of the ovary?

A
  • Fibroma
  • Thecoma
  • Sertoli-Leydig cell tumor
  • Granulosa cell tumor
65
Q

Who may be affected by Granulosa cell tumors?

A
  • Predominantly women in 50s although can affect any age
66
Q

What are the signs/symptoms of granulosa cell tumors?

A

Estrogen excess related signs:

  • Postmenopausal bleeding
  • Endometrial hyperplasia
  • Sexual precocity (preadolescents)
  • Breast tenderness
67
Q

What is the tumor marker for Granulosa cell tumors?

A

Tumor marker: Increased Inhibin

68
Q

What may histology show for a granulosa cell tumor?

A

Call-Exner bodies

- Granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles

69
Q

What may Sertoli-Leydig cell tumor in females look like?

A
  • Small grey to yellow-brown mass
  • Histology shows tubules/cords lined with pink sertoli cells
  • Leydig cells contain Reinke crystals
70
Q

What may Sertoli-Leydig cell tumor in females present?

A

Virilization (hirsutism, male pattern baldness, clit enlargement)

71
Q

What is a fibroma?

A

Benign sex cord stromal tumor

- Bundle of spindle-shaped fibroblasts

72
Q

What is Thecoma?

A

Benign neoplastic proliferation of Theca cells

  • May produce estrogen
  • Presents usually with abnormal uterine bleeding
73
Q

What is Meigs syndrome?

A

Ovarian fibroma with symptoms of:

  • Ascites
  • Pleural effusion
  • “Pulling” sensation in groin
74
Q

What cancers may spread to ovary?

A
  • Kruckenberg tumor -> mucous tumour (usually from gastric carcinoma), also breast, colon
  • Pseudomyxoma peritonei -> mucus in peritoneum (jelly belly) primary source from appendix usually
75
Q

How can you differentiate between a primary mucinous tumor of the ovary and a metastasized tumour?

A

Bilateral usually indicates metastasis

USMLE Reproductive (14 decks)

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